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General NPI Number Information
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NPI Number | 1467997403
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Entity Type | Organization
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Legal Business Name | KOINONIA FOSTER HOMES, INC.
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Dates
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Enumeration Date | 12/29/2016
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Last Update Date | 11/03/2025
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Provider Practice Location Address
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Address Line | 1225 W 190TH ST STE 255
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City | GARDENA
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State | CA
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Zip | 90248-4342
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Country | US
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Telephone | 310-217-0930
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Fax | 310-217-0907
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Provider Business Mailing Address
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Address Line | PO BOX 1403
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City | LOOMIS
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State | CA
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Zip | 95650-1403
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Country | US
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Telephone | 916-652-5802
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JARED RADDIGAN
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Credential |
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Telephone | 916-577-7982
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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